USE OF BUBBLE CONTINUOUS POSITIVE AIRWAY PRESSURE (bCPAP) FOR PREVENTION OF RESPIRATORY DISTRESS IN PRETERM INFANTS

Dr. Mohammed Shaheen*, Dr. Ismat Jahan, Dr. Md. Ismail Hossain, Dr. Mohammad Masudur Rahaman Khan, Dr. Mohammad Neamat Hossain, Dr. Arjun Chandra Dey, Dr. M. A. Mannan and Dr. Mohammod Shahidullah

ABSTRACT

Introduction: Preterm babies contribute the major share of total admission in neonatal intensive care units among the world. Many of these babies present with respiratory distress of variable degrees. Contemporary, continuous positive airway pressure (CPAP) is a popular and effective modality of management of preterm newborns. The commonest use is for respiratory distress syndrome or respiratory distress for any other cause when the baby fails to maintain oxygen saturation because of poor lung compliance. However, prophylactic use of CPAP to prevent respiratory distress in preterm babies is a relatively unexplored subject. It would be interesting to see the effect of elective CPAP in preterm babies in prevention of respiratory distress. Objective: This study was designed to evaluate the efficacy of Bubble CPAP or the prevention of respiratory distress in preterm infants. Method: This randomized trial was carried out at the Neonatal Intensive Care Unit (NICU), Department of Neonatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. A total of 116 inborn preterm (gestational age: 28-32 weeks and / birth weight: 1000-1500gms) infants were enrolled in this study. In the intervention groups, respiratory support was given in the form of Bubble CPAP prophylactically within 30 minutes of birth and in the control group; respiratory support was started considering the severity of respiratory distress as per existing institutional guidelines. If the diagnosis of RDS was made, the baby was given surfactant. Surfactant was administered by InSurE approach (Intubation, Surfactant, and Extubation to CPAP). Result: Prophylactic use of Bubble CPAP decrease the time to improve respiratory distress: (3.14±2.74) vs 3.58±2.12 days, p-value: >0.05); decrease incidence of RDS (40% vs 46%, p- value: > 0.05), decrease requirement of surfactant (20% vs 28%), p-value: >0.05), and decrease switch to mechanical ventilation (14% 18%, p-value: > 0.05). About 80% of both groups had received prenatal steroids. Prophylactic use of BCPAP decrease length of hospital stay (28.34±12.18vs 30.74±12.24 days), increase frequency of sepsis (22% vs 18%), decrease number of ROP (16% vs 22%). Only complications of nasal septal damage (p-value: <0.05) demonstrate statistically significance between the intervention and the control group. Conclusion: Prophylactic use of Bubble CPAP did not show any significant advantage for the prevention of respiratory distress in preterm infants of 28-32 weeks gestation.

Keywords: Preterm Infants, Respiratory distress, Prophylactic Bubble Continuous Positive Airway Pressure, Surfactant, and Mechanical ventilation.